Ratings of satisfaction with the accessibility and quality of health services are useful indicators of community health system performance. Satisfaction ratings offer health system managers, health policy makers, and clinicians insight about consumers' expectations and experiences with health care providers and organizations. Such information can be used to improve the organization, financing, and delivery of health services. Of particular concern is the potential inadequate accessibility and quality of medical care provided to elderly rural residents and Hispanic Americans, two historically vulnerable populations. Unfortunately, relatively few population- based studies of satisfaction with health care accessibility and quality have included both rural and urban Hispanics. Even fewer studies have focused on elders' satisfaction with accessibility and quality. Moreover, there may be regional variation in satisfaction. The purpose of the proposed study is to help close the gap in our understanding of rural/urban and ethnic differences in elderly persons' satisfaction with the accessibility and quality of their health care. It would be conducted in a region with a relatively high percentage of rural residents and persons of Mexican descent. The study sample will be based on participants in a health services research survey of elderly persons (the Texas Tech 5000 survey). Andersen and Aday's behavioral model of health services will be employed to explain how health system, predisposing, enabling, and need factors are associated with perceptions of accessibility and quality. Accessibility and quality will be assessed using measures from the Consumer Assessment of Health Plans Study (CAHPS) questionnaire.